FORM 1023-EZ for USA JIU JITSU INC

Field Data
EIN 82-1582727
Case Number EO-2018257-000451
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name USA JIU JITSU INC
Organization’s Mailing Address 2125 FEAST RD
City MELBOURNE
State FL
ZIP 32904
Accounting period End 12
Primary contact name MITCHEL MILLER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MITCHEL MILLER
DIRECTOR/PRESIDENT
2125 FEAST RD
MELBOURNE FL 32904

Officer/Director/Trustee Two

JORGE GARCIA
DIRECTOR/VICE PRESIDENT
443 MELROSE LANE
SEBASTIAN FL 32958

Officer/Director/Trustee Three

GIANGHAC FLORA BUTLER
DIRECTOR/SECRETARY
PO BOX 120884
MELBOURNE FL 32912

Organization’s website USAJIUJITSU.NET
Organization’s email USAJINJITSU.MESSAGE@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/17/17
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N99 - Recreation, Sports, Leisure, Athletics N.E.C.
Organization’s purpose Charitable: No
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: Yes
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name MITCHEL MILLER
Signature Title DIRECTOR/PRESIDENT
Signature Date 9/12/18

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